Paroxysmal disorders

Ptacek, L. J. Channelopathies ion channel disorders of muscle as a paradigm for paroxysmal disorders of the nervous system. Neuromusc. Disord. 7 250-255,1997. 

Seizure—Paroxysmal disorder of central nervous system, characterized by abnormal neuronal discharges with or without loss of consciousness. They vary in cause, presentation, consequences, duration, and management. 

Paroxysmal Disorders. Migraines are paroxystic, intense hemicranial pain episodes, accompanied by vomiting and light sensitivity. The cause of these episodes is still unclear. Acute treatment of migraine employs drugs such as sumatriptan and ei otamine, while prophylactic therapy uses various agents such as propranolol, verapamil, amitriptyline, and valproate. 

O Determining a correct and accurate diagnosis is essential prior to any consideration of pharmacotherapy. When a patient complains of paroxysmal, stereotypical spells that may be seizures, it must be determined if the spells are really seizures. Numerous other disorders, including syncope, psychogenic nonepileptic events (i.e., pseudoseizures), anxiety attacks, cardiac arrhythmias, hypoglycemia, transient ischemic... 

Trigeminal neuralgia A disorder of the fifth cranial (trigeminal) nerve characterized by excruciating paroxysms of pain in the face. 

Patients with secondary hypertension may complain of symptoms suggestive of the underlying disorder. Patients with pheochromocytoma may have a history of paroxysmal headaches, sweating, tachycardia, palpitations, and orthostatic hypotension. In primary aldosteronism, hypokalemic symptoms of muscle cramps and weakness may be present. Patients with hypertension secondary to Cushing s syndrome may complain of weight gain, polyuria, edema, menstrual irregularities, recurrent acne, or muscular weakness. 

It is effective orally and resistant to pseudo-cholinesterase and possesses longer duration of action. Its nicotinic action is less than acetylcholine and actions are more marked on CVS as compared to GIT and urinary system. Earlier it was used for CVS disorders such as peripheral vascular disease and paroxysmal supraventricular tachycardia. But now, it is rarely used in therapeutics. 

Of note, the FDA has only approved CBZ for certain seizure and paroxysmal pain disorders, but not for the treatment of mood disorders. While the use of drugs for other than FDA-labeled indications is a common and appropriate practice, this should always be discussed with patients, as well as their families. Proper documentation includes the discussion of the rationale and the potential complications (see also the section Informed Consent in Chapter 2). 

Epilepsy is a chronic neurologic disorder characterized by recurrent seizures.33 Seizures are episodes of sudden, transient disturbances in cerebral excitation that occur when a sufficient number of cerebral neurons begin to fire rapidly and in synchronized bursts.42 Depending on the type of seizure, neuronal activity may remain localized in a specific area of the brain, or it may spread to other areas of the brain. In some seizures, neurons in the motor cortex are activated, leading to skeletal muscle contraction via descending neuronal pathways. These involuntary, paroxysmal skeletal muscle contractions seen during certain seizures are referred to as convulsions. However, convulsions are not associated with all types of epilepsy, and other types of seizures are characterized by a wide variety of sensory or behavioral symptoms. 

Native Americans used hawthorn as a diuretic for kidney and bladder disorders and to treat stomachaches, stimulate appetite, and improve circulation. The flowers and berries have astringent properties and can be used to treat sore throats in the form of haw jelly or haw marmalade. Today, hawthorn is promoted for the treatment of heart failure, hypertension, arteriosclerosis, angina pectoris, Buerger s disease, paroxysmal tachycardia, heart valve murmurs, sore throat, skin sores, diarrhea, and abdominal distention. 

Daily administration of colchicine is useful for the prevention of attacks of familial Mediterranean fever (familial paroxysmal polyserositis) and for prevention and treatment of amyloidosis in such patients. Colchicine appears to benefit patients with primary biliary cirrhosis in terms of improvement of liver function tests and perhaps of survival. Colchicine also has been employed to treat a variety of skin disorders, including psoriasis and Behcet s syndrome. 

Hepatic venous thrombosis, also known as Budd-Chiari syndrome, is caused by hypercoagulable disorders precipitated by pregnancy, infection, and birth control medication. An acute painful abdomen, sudden enlargement of the liver, and the presence of ascites make up a triad of clinical symptoms that are important in the diagnosis of this syndrome. Myeloproliferative disorders such as polycythemia vera and paroxysmal nocturnal dyspnea were previously thought to be responsible. Factor V Leiden and prothrombin 20210 mutations are also known to be responsible, Other intraabdominal thromboses include portal vein thrombosis, mesenteric vein thrombosis and renal vein thrombosis. 

Lindemann S, Lessenich A, Ebert U, Loscher W (2001) Spontaneous paroxysmal circling behavior in the ci2 rat mutant Epilepsy with rotational seizures or hyperkinetic movement disorder Exp Neurol 172 437-445. 

Berner J. Lithium-treated mood disorders, paroxysmal rhi-norrhea, and mesial temporal lobe epilepsy. J Neuropsychiatry Clin Neurosci 1999 11(3) 414—5. 

Paroxysmal nocturnal hemoglobinuria is a very rare acquired disorder in which hemopoietic stem cells become peculiarly sensitive to complement-mediated lysis. Venous and possibly arterial thrombosis occurs in the brain and elsewhere. Patients are nearly always anemic at... 

Verapamil, proprietaiy name Calan, is a calcium channel blocker that is effective in the treatment of various cardiovascular disorders, including angina (classical and variant), arrhythmias (paroxysmal supraventricular tachycardia), atrial flutter, atrial fibrillation, hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis), hypertension, congestive heart failure, and Raynaud s phenomenon, along with the preservation of ischemic myocardium and the treatment of migraine headaches. 

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